Impact of a Standardized Institutional Policy on Surgical Antimicrobial Prophylaxis in a Tertiary Care Hospital

Background: Surgical antimicrobial prophylaxis (SAP) is a critical measure in preventing surgical site infections. However, inconsistent practices and a lack of adherence to evidence-based guidelines often compromise its effectiveness. This study evaluated the impact of a standardized institutional SAP policy on the appropriateness of antibiotic choice and timing in a tertiary care hospital in South India. Methodology: A nonrandomized prospective interventional study was conducted from September 2023 to August 2024. Surgical patients undergoing elective clean and clean-contaminated procedures were included. A baseline audit ( n = 317) assessed SAP practices across seven surgical departments. A hospital-specific SAP policy was then developed in line with ASHP 2013 and ICMR 2017 guidelines, incorporating input from surgical teams and local antibiogram data. Postintervention audit data ( n = 230) were collected after policy implementation. Compliance in antibiotic selection and timing relative to surgical incision was compared pre- and postintervention using Chi-square analysis. Results: Compliance with appropriate antibiotic choice significantly improved from 68.7% in the preintervention phase to 98.7% postintervention ( P < 0.00001). Similarly, compliance with the appropriate timing of administration increased from 64% to 75.2% ( P = 0.0054). Key barriers identified during baseline included inconsistent antibiotic availability and administration delays due to preoperative dosing in the wards. Policy implementation, real-time audits, and staff sensitization addressed these gaps. Conclusion: The introduction of a standardized institutional SAP policy markedly enhanced adherence to evidence-based practices regarding both antibiotic selection and timing. The results underscore the need for localized policy development, stakeholder consensus, and operational integration to improve SAP compliance.